运用CBCT分析角度螺丝通道在上颌切牙区早期及延期种植修复中应用的可行性

The applicability of angulated screw channels in early and delayed implant restorations in maxillary incisor sites based on CBCT analysis

目的 通过锥形束CT(cone beam computer tomography,CBCT)数据研究角度螺丝通道(angulated screw channel,ASC)在上颌切牙早期及延期种植修复中应用的可行性。方法 选择114位符合纳入标准的受试者CBCT数据,共119个上颌切牙位点,在Simplant软件中参考对侧同名牙的形态对缺牙区进行虚拟修复体牙冠设计,并在此基础上进行种植体虚拟植入,测量以修复为导向与以牙槽骨骨量为导向虚拟植入种植体之间的夹角,以及以牙槽骨骨量为导向虚拟植入种植体时螺丝通道在理想修复体牙冠上的穿出位置,并记录实现螺丝通道从腭侧穿出时所需ASC的最小角度。结果 在119颗上颌切牙虚拟种植方案中,以修复为导向与以骨量为导向虚拟植入种植体之间存在夹角,且在不同性别、不同牙位之间存在统计学差异,女性的夹角大于男性,中位数分别为10.00°(5.30°~14.15°)和6.80°(3.80°~9.30°),侧切牙的夹角大于中切牙,中位数分别为14.45°(9.80°~19.43°)和6.50°(3.85°~9.75°)。以骨量为导向虚拟植入种植体螺丝通道在理想修复体牙冠不同位置穿出比例在不同性别之间的差异无统计学意义,在中切牙、侧切牙牙位之间的差异存在统计学意义,侧切牙从牙冠唇面加切端穿出的总比例高于中切牙。在119个位点的虚拟种植修复方案中,直螺丝通道螺丝固位、ASC螺丝固位、粘接固位3种种植修复方式的比例分别为16.8%、81.5%和1.7%。结论 上颌切牙早期及延期种植修复中,存在着纠正修复体与牙槽骨方向之间的差异、实现螺丝固位种植修复的需求,绝大多数上颌切牙缺失位点可以通过ASC实现螺丝固位种植修复,侧切牙位对ASC的需求较中切牙位更大。

Objective To evaluate the ability of the application of angulated screw channel(ASC)in early and delayed implant restorations in maxillary incisor sites by cone beam computed tomography(CBCT)analysis.Methods CBCT data from 114 patients with 119 incisor sites in the maxilla that met the inclusion criteria for digital implant planning were selected.The virtual restoration crown was designed by referring to the morphology of the contralateral tooth,and the virtual implant was planned using Simplant software.The angle between the prosthetic-driven virtual implant and the alveolar bone-driven virtual implant was measured,the location of the penetration of the screw channel in the virtual crown was confirmed according to the alveolar bone volume-driven virtual implant,and the minimum angle of the ASC required for the screw access to be implanted palate in the virtual crown was recorded.Results Among 119 sites of maxillary incisors,there were angles between the prosthetic-driven implant and the bone-driven implant in most sites.The angels in females(median 10.0°,quartile range 5.30°-14.15°)were statistically larger than those in males(median 6.80°,quartile range 3.80°-9.30°),and those in lateral incisors(median 14.45°,quartile range 9.80°to 19.43°)were greater than those in central incisors(median 6.50°,quartile range 3.85°to 9.75°).There was no statistical difference in the proportion of the location of the opening of the screw access in the virtual crown between males and females.At the same time,there was a statistical difference between central and lateral incisor sites,where the proportion of the labial plus incisal location was higher in lateral incisor sites than in central incisor sites.The proportions of straight screw channel screw-retained restoration,angulated screw channel screw-retained restoration,and cement-retained restoration in all the implant restoration protocols were 16.8%,81.5%,and 1.7%,respectively.Conclusions In early implant and delayed implant restorations of maxillary incisors,it is necessary to compensate for the discrepancy between the crown and the alveolar bone orientation to complete a screw-retained implant restoration.Screw-retained implant restorations could be achieved in most maxillary incisal sites using ASC.Lateral incisor sites presented a greater need for ASC than central incisor sites.